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<br />813-78D-0020 <br /> <br />Date Received <br />Mi:KHW~& <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br />ELECTRICIANI <br />Signature , <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICAL1 <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address <br />Directions: <br /> <br />City of Zephyr hills Fife' <br />Permit Application <br /> <br /> <br />It Sq z. <br /> <br />II <br /> <br />O~I L.'E7'f <br /> <br />;tr 1 B v5 <br /> <br />Fax-813-78D-0021 <br /> <br />lJ <br /> <br />Phone Contact for Permit <br /> <br /> <br />II <br /> <br />II <br /> <br />Owner's Phone Number <br /> <br />I I II <br />Titleholder Phone Number , <br /> <br />"__,,,rrmll'lf~- _m_ =B1ii_!l".MI~~m>i!.iffi-- <br />I Lot# <br /> <br />Parcel # <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />D Places of Assembly-ANNUAL <br /> <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch RoofingfTar Kettle <br />D Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />I <br /> <br />Fee Simple Titleholder Address I <br /> <br />LlOOJ.~ <br />I <br /> <br />~~~lli~Dj <br /> <br />~.L:.< _ <br /> <br />~ <br /> <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />~~~D <br />:~:::~ ~ ~ ~ ~CJ <br /> <br />Hood Cleaning 0 0 0 0 CJ <br />Hood Suppression 0 0 0 0 CJ <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br />Fuel Tanks <br />Other: <br /> <br />OJllf&il~~~--"'-"1:: <br /> <br />1m <br /> <br />-.. <br /> <br />I ,.&i~U_ <br /> <br />I <br />'I!Illifu <br /> <br />I <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br /> <br />0.-. ~ <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />License # <br /> <br />Fill out application completely. <br />Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br />If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br />Supply two (2) sets of drawings with applicable documentation <br />Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />